ABCD-DUK Survey of Specialist Diabetes Services 2006 • Working party : Peter Winocour , Charlotte Gosden, Richard Holt, Bridget Turner, Chris Walton, Dinesh Nagi, June James, Rhys Williams • Objectives: 1. To identify existing provision in specialist services and changes since previous ABCD 2000 survey 2. To record issues affecting working practices of consultant diabetologists and make comparison with 2004 NDST Diabetologist scoping project
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ABCD-DUK Survey of Specialist Diabetes Services 2006 Working party : Peter Winocour, Charlotte Gosden, Richard Holt, Bridget Turner, Chris Walton, Dinesh.
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ABCD-DUK Survey of Specialist Diabetes Services 2006
• Working party : Peter Winocour , Charlotte Gosden, Richard Holt, Bridget Turner, Chris Walton, Dinesh Nagi, June James, Rhys Williams
• Objectives: 1. To identify existing provision in specialist services
and changes since previous ABCD 2000 survey2. To record issues affecting working practices of
consultant diabetologists and make comparison with 2004 NDST Diabetologist scoping project
ABCD-DUK Survey of Specialist Diabetes Services 2006
ABCD-DUK Survey of Specialist Diabetes Services 2006 – Well resourced service score
Service score (Retinopathy screening excluded )
2006 ABCD-DUK survey *
A* 0.4%
A 25.2%
B 34.8%
C 23.9%
D 13.5%
E 2.2%
ABCD-DUK Survey of Specialist Diabetes Services 2006 – Well resourced service score
Region A*-A score B-C score D-E score
Yorks and Humber
57% 43% 0%
North East 43% 50% 7%
London 29% 46% 25%
Eastern 24% 57% 19%
South East Coast
13% 53% 34%
ABCD-DUK Survey of Specialist Diabetes Services 2006 –Perceptions of service and job
satisfaction
• 36% felt service not well resourced (39.5% scored C,D,E)
• Current job satisfaction : Good or Excellent in 48% (Possibly lower than in 2004 Scoping project)
ABCD-DUK Survey of Specialist Diabetes Services 2006 – Threats to specialist services
• Commissioning Issues• Capacity and Staffing• Perception of DM as
non-complex low priority
• Funding • Community Shift• Acute-GIM
• System reform• National Politics• Training of juniors• Consultants under-
valued
ABCD-DUK Survey of Specialist Diabetes Services 2006 –Best aspects of Acute –GIM
• Broad Case-Mix
• Diagnostic challenges
• Teaching
• Enjoyment of pace of acute medicine
ABCD-DUK Survey of Specialist Diabetes Services 2006 –Worst aspects of Acute –GIM
• Lack of continuity of care
• Excessive demand on consultant-led input
• Increased junior dependency on seniors
• Impact of opt out of other specialties on ward case-mix
• Lack of beds and blocked discharge of CoE
• Govt targets skewing care
ABCD-DUK 2006 Survey – Summary and Discussion -1
• Methodology challenging – may have reduced response rate to around 50%
• Evidence of real increases in staffing levels since 2000 – with improvements in provision of some sub-specialist services
• Continued deficiencies in diabetes registers and psychology support
ABCD-DUK 2006 Survey – Summary and Discussion -2
• Virtually all respondents involved with GIM with impact on specialty activity
• Other physicians recorded as opting out of Acute GIM in over 2 in 3 responses
• Average committment to DM is < 30% of programmed activities
• Less than 25% engaged in community DM
ABCD-DUK 2006 Survey – Summary and Discussion -3
• Specialist service considered not well resourced in over 1/3 responses with possibility of continued regional disparity
• Real possibility of waning job satisfaction in 2 years with concerns re. external influences on specialist service and operation of Acute GIM
• Apparent uncertainty about and lack of engagement in discussions on service commissioning models
Pressures on the Consultant Diabetologist –The unique
Quadruple Whammy !!
AcuteMedicine
Other consultants opting out of acute medicine
Community shifts- acute trust priorities
Non-physician‘specialists’
Implications of findings
• Articulate the view that the future of effective integrated DM care, enhanced specialist DM service and safe hospital care of both acute GIM and DM requires a national commitment to :
• Funded consultant posts in GIM-DM or DM to serve population needs – with a range of roles for DM service from a pool of consultants
• Expansion of consultant posts to support both DM and increasing commitment to acute-GIM
• Training programmes to recognise the shift in DM specialist services
Action Plan
• Publicity drive to positively push the desire of specialist diabetologists to engage in new service models
• Enagagement with media and information cascade to DoH, SHAs , commissioners (PCTs and PBC) and acute trust chief executives
• Political lobbying• Support via RCPs, PCDS and ABCD-DUK• National Clinical Director support for proposals